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Eur J Cardiothorac Surg 2005;28:833-837
© 2005 Elsevier Science NL

Quality assessment of distal S²AS connector anastomosis by 13 MHz epicardial ultrasound

^a Heart Lung Center Utrecht, University Medical Center Utrecht, Room G02.523, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
^b Isala Clinics, Zwolle, The Netherlands
^c iiTech BV, Amsterdam, The Netherlands

Received 11 April 2005; received in revised form 16 August 2005; accepted 24 August 2005.

^_* Corresponding author. Tel.: +31 30 2507155; fax: +31 30 2522693. (Email: utrecht.cardioresearch{at}hli.azu.nl; p.f.grundeman{at}hli.azu.nl).

Objective: During application of a distal coronary bypass connector, we employed 13 MHz epicardial ultrasound to evaluate quantitative caliper measurements for vessel size matching and to assess anastomosis quality after connector deployment. Methods: Two S²AS connector anastomoses were constructed on ex vivo pressure-perfused porcine hearts. Epicardial ultrasound measurements of the connector ring and anastomosis were compared to intravascular ultrasound measurement and cast dimensions. In 21 pigs, anastomotic sites with internal diameter of 2.25–3.0 mm (internal mammary artery, IMA) and 1.8–2.2 mm (left anterior descending coronary artery, LAD) were selected using external caliper and epicardial ultrasound measurements. Anastomoses were visualized and assessed intraoperatively (beating heart, n = 21) and at 3 and 6 months’ follow-up (explanted heart, n = 10 each). Results: Epicardial ultrasound underestimated connector dimension by 5% versus intravascular ultrasound and deviated 13% from cast dimensions for other anastomotic measurements. Caliper estimates of internal IMA and LAD diameter differed from ultrasound by –3 ± 6% and –2 ± 7% (mean ± SD), respectively. Intraoperatively, the anastomotic orifice was flawless in all animals. It remained fully patent at 3 and 6 months by ultrasound, which was confirmed by histology. The connector to LAD percentage diameter stenosis changed from –12 ± 5% intraoperatively to –1 ± 7% at 3 months and from –5 ± 6% intraoperatively to –16 ± 13% at 6 months, in the growing pig model. Conclusions: In the pig, external caliper measurements provided a reliable quantitative estimate of inner graft and coronary diameter for connector size matching. Epicardial 13 MHz ultrasound is a promising method to assess coronary anastomosis quality even when connector metal is present.

Key Words: Anastomosis • Coronary artery bypass grafting • Echocardiography • Minimally invasive • Off-pump • Ultrasound

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